Acute appendicitis is one of the most common surgical emergencies. Traditionally treated by open appendectomy, the introduction of the laparoscopic technique has revolutionised its management. In this article, we compare these two techniques, with a focus on their long-term results and applicability in different age groups.
Laparoscopic technique
- Advantages: Laparoscopic appendectomy, performed through small incisions using a camera, is known for less postoperative pain and faster recovery. Improved visibility of the abdomen may reduce misdiagnosis rates, especially in women of childbearing age.
- Results: Studies have shown a lower incidence of wound infections and a faster return to normal activities. In addition, post-surgical scars are less noticeable.
- Special Considerations: Although it is a safe and effective technique, it requires specific skills and can be more expensive compared to open appendectomy.
Open Technique
- Advantages: This conventional approach allows direct access to the appendix and is preferred in cases of complicated appendicitis, such as in the presence of an abscess. It is also considered in patients with contraindications to laparoscopy.
- Results: Although recovery may be longer and postoperative pain more significant, the open technique remains the gold standard, especially in resource-limited settings or when laparoscopy is not available.
- Special Considerations: Open appendectomy can be quicker and less expensive compared to laparoscopic appendectomy, and is a widely taught and practised technique.
Comparative Analysis and Recommendations
- Age groups: While laparoscopy may be particularly beneficial for young patients and adults due to aesthetic factors and rapid recovery, in older patients or those with significant comorbidities, the choice of technique should be carefully evaluated.
- Long-term results: Both techniques have been shown to be effective in the long term, but the choice between one or the other should be based on the patient's clinical presentation, co-morbidities and the surgeon's skills.
- Cost and availability: The availability of resources and the experience of the surgical team are crucial factors in decision-making. In regions where laparoscopy is not feasible, open appendectomy remains a safe and effective option.
Conclusion
The management of acute appendicitis has evolved significantly with the introduction of laparoscopy. However, the choice between laparoscopic and open appendectomy must be personalised, based on the individual clinical situation, the patient's preferences, and the capabilities of the surgical centre. This article aims to inform healthcare professionals about the advantages, limitations and considerations of each technique, promoting evidence-based, patient-centred practice.